Forensic Considerations in Cases of Myotonic Dystrophy at Autopsy

Myotonic dystrophy (DM) is a chronic, slowly progressive, autosomal‐dominant disorder with delayed muscle relaxation after contraction, distal skeletal muscle weakness, and atrophy. It has a reduced life expectancy due predominantly to respiratory failure or sudden cardiac death. The mortality rate is approximately 7.3 times greater than the general population with a mean age at death of 53 years. Degeneration of the cardiac conduction system causes atrioventricular block, arrhythmias, and ventricular failure. A case of sudden death in a 44‐year‐old woman with DM type 1 is reported to demonstrate an alternative lethal mechanism. At autopsy, there was extensive infiltration of skeletal muscles with adipose tissue. The heart was structurally normal. A deep venous thrombosis of the right calf was identified with a large saddle pulmonary thromboembolus and bilateral peripheral thromboemboli. DM1‐related thrombosis had most likely occurred because of the decedent's impaired mobility, possible hypercoagulable state, and serum changes from muscle necrosis.     

A Characterization of Sources of Isopropanol Detected on Postmortem Toxicologic Analysis

Abstract: Isopropanol is an important chemical to forensic pathologists in that intoxication can result in death yet presence does not necessarily indicate intoxication. Several reports have been published, which indicate that isopropanol can be created endogenously in certain situations including diabetes mellitus, starvation, dehydration, and chronic ethanol use; however, a large‐scale analysis addressing all of the possible causes of postmortem isopropanol detection has not been performed. A retrospective review of all cases examined at the Bexar County Medical Examiner’s Office between 1993 and 2008 in which isopropanol was detected in routine alcohol screening was undertaken. The cases were categorized by the source of the isopropanol, and the concentrations of isopropanol and acetone were analyzed. Analysis revealed isopropanol concentrations to be low (<100 mg/dL) in cases of antemortem and postmortem creation and in postmortem contamination and high (>100 mg/dL) in cases of antemortem exposure. These results are consistent with other published reports.     

Testing an Age-old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths?

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.     

Digging Up, Dismantling, and Redesigning the Criminal Law

The criminal law raises wonderfully thorny foundational questions. Some of these questions are conceptual: What is a plausible conception of crime? What is a plausible conception of criminal law? Some of these questions are genealogical: What are the historical and genealogical roots of the criminal law in a particular jurisdiction? Other questions are evaluative: What are the political and moral values on which a given conception of criminal law depends? What kind of rational reconstruction, if any, could the criminal law be given? And, finally, still other questions are exploratory and normative: Should parts of existing criminal law be abandoned? What new topics in criminal law theory need to be addressed in our globalised, technologically savvy world? The contributors to Antony Duff and Stuart P. Green’s collection Philosophical Foundations of Criminal Law tackle these questions with zeal and independent spirit. They disagree markedly with each other about what the foundational questions are. And, they disagree about how those questions should be handled. This article charts their disagreements by situating the contributors within two taxonomies. The first groups them according to their approaches to the foundational questions; the second groups them according to their modes of theorising. This double taxonomy provides a useful frame within which to analyse these competing takes on the philosophically foundational work of criminal law theory.     

Motivated to Adapt? The Role of Public Service Motivation as Employees Face Organizational Change

Researchers concerned with organizational change have consistently emphasized the role that the work environment plays in employee acceptance of change. Underexamined in the public management literature, however, is the role that employee values, particularly public service motivation (PSM), may play in employee acceptance of change. Some scholars have noted a positive correlation between employee PSM and organizational change efforts; this article extends this work by attempting to isolate the mechanisms that explain this relationship. Using data from a survey of employees in a city undergoing a reorganization and reduction in workforce, the authors find that only employees who scored high on a single dimension of PSM—self‐sacrifice—were more likely than others to support organizational change. Rather than support changes for their potential to improve public service, this finding suggests that employees with higher PSM may simply be less likely to resist changes that might disadvantage them personally.     

Justifying Punishment: A Response to Douglas Husak

In ‘Why Criminal Law: A Question of Content?’, Douglas Husak argues that an analysis of the justifiability of the criminal law depends upon an analysis of the justifiability of state punishment. According to Husak, an adequate justification of state punishment both must show why the state is permitted to infringe valuable rights such as the right not to be punished and must respond to two distinct groups of persons who may demand a justification for the imposition of punishment, namely, individuals subjected to punishment and the society asked to support the institution of punishment. In this discussion, I analyse Husak’s account of the right not to be punished with an eye to showing that the parameters of that right do not extend to the cases that would make it controversial. I also consider two other distinct groups of persons who have equal standing to alleged offenders and society to demand justification for the imposition of state punishment, namely, direct victims of crimes and criminal justice officials.     

Aligning Ideologies and Institutions: Reorganization in the HIV/AIDS Services Administration of New York City

How effective was organizational reform implemented inside one critical New York City health agency? Specifically, we examine the extent to which the reorganization of the HIV/AIDS Services Administration (HASA) into the Medical Insurance Services Administration (MICSA) achieved three goals: (1) realizing synergies among the component MICSA programs; (2) cross‐fertilizing ideas among MICSA agencies; and (3) facilitating HASA operations through the lens of organization change theory. Qualitative methods including interviews, site visits, and document analysis triangulate the effects of the reorganization. Implications for organization change literature are explored, especially highlighting where more theoretical and empirical studies are needed.